Botox Helps Some Urinary Problems

May 25, 2002 -- Botox isn't just for crow's feet anymore. Strange as it may sound, people with serious bladder problems may get some relief from a Botox injection.

Botox -- one of the world's most toxic substances -- blocks the ability of nerves to tell muscles to contract. "Wherever you put it, that muscle will not be able to contract until the nerve grows back in about four to six months," explains Michael Chancellor, MD, professor of urology and gynecology at the University of Pittsburgh School of Medicine.

He presented his study at the American Urological Association annual meeting today.

"It's pretty cool," Chancellor tells WebMD. "People think Botox is just for facial wrinkles. But just like the face, the bladder and other internal organs are mostly made of muscle. When those internal organs spasm, Botox can quiet them down."

Chancellor's patients had a variety of disorders -- multiple sclerosis, spinal cord injury, stroke, and overactive bladder. They also had urinary problems caused by muscle spasms in the bladder or in the sphincter, which is the valve that controls urine release. Some were not able to control their bladder -- what's known as "urge incontinence." Some were completely unable to urinate and needed a catheterization.

"These were not people with a mild problem," Chancellor tells WebMD. "They had tried every drug out there without success."

After receiving Botox injections into the bladder or the urethra, 41 of the 50 patients -- 82% -- reported a decrease or absence of their urinary problems, he reports.

"Approximately two-thirds of the patients had significant improvement," he tells WebMD. Also, none of the patients had any long-term complications, such as stress incontinence -- a minor leakage problem that occurs when you laugh, sneeze, or cough.

"If you've tried exercise and pills, if you're really miserable and changing diapers a couple of times a day, Botox may be able to help you," he says.

The downside: it's an invasive procedure (it needs to be done under light sedation), it must be redone every six months or so, and it's expensive, says Chancellor. "Insurance companies don't want to cover Botox. That's been the biggest problem."

"Certainly it's a viable option, even though the duration of effect may be relatively short-lived," says Niall Galloway, MD, medical director of the Emory Continence Center at Emory University School of Medicine in Atlanta.

Trouble is, too many patients wait too long before getting treatment for their incontinence problem -- which makes it harder to treat, Galloway tells WebMD. "They are looking for a resolution to problems that oftentimes have been there for as long as seven years. With almost everything in medicine, the longer you have it, the harder it is to reverse it simply. So if you get on the problem early -- certainly within months -- it's easier to treat."

While there are numerous treatments for urge incontinence, the problem is also related to drinking excess fluids such as coffee or soda, or eating chocolate, spicy foods, and fruits rich in potassium -- all of which stimulate bladder contractions.

Incontinence problems sometimes are caused by another condition such as pregnancy, uterine fibroids, ovarian cysts, urinary tract infections, a constipated bowel, or bladder tumors, Galloway tells WebMD. "You need to be quite clear that it is a bladder problem, not another condition that is causing similar symptoms." -->